Our project highlights one of the primary areas of research within the Kansas Intellectual and Developmental Research Center? language and communication. Specifically, we focus on language and communication in children with autism and minimal verbal skills (less than 20 spoken words). Remaining nonverbal past the age of 5 years has been considered a poor prognostic indicator for future language developments (Picket et al., 2009), yet few interventions have been developed to address this problem. The Specific Aims for this project are (1) to further investigate a multimodal intervention for school-age children with minimal verbal skills? defined as less than 20 words spontaneously spoken, signed, or selected via graphic symbol selection?and (2) to identify significant covariates associated with differential responding to the intervention. The research addresses an unmet need to promote spoken word production in children who remain essentially nonverbal well past the ages associated with speech acquisition. The project is also innovative because: a) it investigates a multimodal intervention based on principles of phonotactic probability and neighborhood density in combination with augmentative and alternative communication (AAC), and b) it investigates novel predictors of treatment response that are obtained through cutting-edge technologies. We propose that this intervention will have better success than past interventions because we will provide increased input through speech, digitized speech and visual images and additional speech sound practice for words that are comprised of high frequency sounds in the child?s repertoire. Extant speech sounds in each participant?s repertoire will be identified using LENA digitized recordings. Vocabulary words will then be selected based on a child?s speech sound repertoire and principles of word learning?words with high probability speech sound sequences will be selected and taught with either our multimodal intervention or a treatment as usual condition. Responses to these interventions will be evaluated using a Sequential Multiple Assignment Randomized Trials (SMART) design. We propose that different outcomes will be associated with individual and environmental predictors identified in our previous research. Individual predictors include verbal comprehension, imitation skills, adaptive behavior, nonverbal speech sound repertoire, and communication complexity. Communication complexity will be measured with the Communication Complexity Scale (CCS), developed by the Principal Investigator. Environmental predictors include language input to the child as measured with LENA recording devices. Results will determine if our multimodal intervention is more successful than treatment as usual for teaching word productions, but will also identify the individual and environmental profiles associated with differential outcomes. Our discoveries will lead to more focused clinical trial research and will inform customized intervention practices in schools and clinics. Ultimately this line of research aims to improve the lives of children with autism and their families through enhanced communication skills.